Two bills under consideration by the North Dakota Legislature seek to address the ongoing challenges of dental care accessibility for low-income and underserved groups across the state. Advocates for the bills argue that while they are a step in the right direction, they are only the beginning of addressing the significant gaps in dental care within the state.
House Bill 1567 proposes a study to assess the dental health of Medicaid recipients and explore ways to recruit dental professionals to improve care access, particularly for low-income children, Native American children, and individuals with disabilities.
Senate Bill 2231 aims to extend dental coverage to Medicaid Expansion, a health insurance program for adults whose incomes are below 138% of the federal poverty level but who do not qualify for traditional Medicaid. Currently, Medicaid recipients receive dental benefits, but those under Medicaid Expansion do not, a disparity supporters of the bill seek to address.
Rep. Mary Schneider, D-Fargo, one of the sponsors of House Bill 1567, emphasized the urgency of taking action, stating, “We need effective and permanent ways to address lack of dental access for groups who rely on Medicaid for oral health.”
Tammy King, executive director of Bridging the Gap, a nonprofit dental clinic in Bismarck, highlighted the confusion faced by patients who mistakenly believe they are covered under Medicaid for dental care, only to discover they are enrolled in Medicaid Expansion, which does not offer dental benefits. King explained that while the clinic offers discounted rates for these patients, the lack of clarity is frustrating for both staff and patients.
The addition of dental benefits to Medicaid Expansion, according to Nadine Boe, CEO of Northland Health Center in Turtle Lake, would not only encourage patients to seek preventive and restorative dental care but would also help reduce emergency room visits for tooth pain, which are both costly and avoidable. With higher Medicaid reimbursements, Boe believes her center would be more financially sustainable and better positioned to recruit additional dentists and potentially expand its services.
Northland Health Center is one of five federally qualified health centers in the state, offering primary medical care, behavioral health services, and dental care to all patients, regardless of their ability to pay. Shelly Ten Napel, CEO of the Community HealthCare Association of the Dakotas, emphasized that while adding dental benefits to Medicaid Expansion would not resolve all challenges, it would bring much-needed resources to the dental care system.
With approximately 23,300 North Dakotans enrolled in Medicaid Expansion, the cost of adding dental benefits would be approximately $500,000 for the state, with an additional $4.6 million from federal funds. However, lawmakers argue that this cost may be offset by savings in emergency care. In 2021, over 1,700 North Dakotans visited emergency rooms for tooth pain, according to the state Department of Health and Human Services.
Sen. Judy Lee, R-West Fargo, a sponsor of the Senate bill, believes that adding dental coverage to Medicaid Expansion will ultimately reduce overall healthcare costs by encouraging earlier care and preventing costly emergency visits. “People will seek care earlier, so they won’t miss as much school and work,” she said.
While expanding coverage is a critical step, the state faces broader challenges in meeting dental care needs, particularly in rural and low-income areas. A report from the Department of Health and Human Services found that only 44% of the need for dental providers in the state is being met, with the greatest shortages in rural regions. Additionally, oral health issues like tooth decay and gum disease are linked to serious conditions such as diabetes, heart disease, stroke, and low birth weight.
House Bill 1567 proposes a legislative study to examine barriers that prevent people from seeking dental care and to understand why some private dental clinics limit or refuse to accept Medicaid patients. Rep. Schneider stressed the need to identify and address these barriers, noting, “We’ve documented unmet needs, but we haven’t addressed the barriers in the system. That’s where we need to make progress.”
Bridging the Gap, which serves Medicaid beneficiaries as well as the uninsured and underinsured, often receives calls from people struggling to find clinics that accept new Medicaid patients. King stated that many dental providers are at capacity and unable to take on more Medicaid patients, leaving Bridging the Gap as one of the few options for those seeking care.
With a legislative study already underway, advocates hope that the state will take the necessary steps to expand access to dental care, recruit more providers, and address the root causes of North Dakota’s dental care shortages.
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